3. Mental disorder
statistics
❖ 450 million persons suffer from mental disorders globally
❖ Account for 25% of disabilities in the United States, Canada, and Western
Europe
❖ 1 and 10 children in the US has a mental disorder that causes some form
of impairment
❖ Evident among ALL ethnic, racial, cultural groups, and every
socioeconomic level
❖ Alone, costs the US $150 billion dollars annually excluding research
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a1.htm
4. Integral to overall health and well-being
❖ Mental illness can influence the onset,
progression, and outcome of other
illnesses
❖ Often correlates with health risk
behaviors such as substance abuse,
tobacco use, and physical inactivity
❖ Depression as a risk factor:
➢ Hypertension, cardiovascular disease,
and diabetes
➢ Can adversely affect course and
management of such conditions
❖ Treatment is available and is considered
effective
❖ A majority of diagnosed persons do not
receive treatment
❖ Secondary Impairments
➢ Social: unemployment, social adversity,
institutionalisation
➢ Psychological: dependent or
semi-independent on family or
institutions
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a1.htm
5. Public health challenges
❖ Identify risk factors
❖ Increase awareness about mental disorders and effectiveness of
treatment
❖ Remove associated stigmas
❖ Eliminate health disparities
❖ Improve access to mental health services
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a1.htm
7. What is schizophrenia?
❖ Severe mental disorder characterized by profound disruptions in thinking,
affecting language, perception, and the sense of self
❖ Includes psychotic experiences (hearing voices or delusions) and can
impair functioning through loss of capability to earn a livelihood or
disruption of studies
❖ Begins in late adolescence / early adulthood
❖ Genetically predisposed/ stressor induced
❖ Affects 21 million people worldwide
➢ 1 out of every 2 people living with schizophrenia do not receive treatment
■ Bigger picture: 50% of people go untreated
http://www.who.int/mental_health/management/schizophrenia/en/
8. Stress
❖ Schizophrenia arises as a specific consequence of severe
stress associated with life events or crisis without the
presence of any underlying vulnerability
❖ Timing is influenced by the experience of life events
❖ The probability of an episode is influenced by stressful life
events
Schizophrenia, Birchwood and Jackson 2001
9. Socioeconomic Status
❖ Developed countries show
schizophrenia and other mental
illnesses are common in the lower
socioeconomic groups
❖ Three explanations could account for
high rates in poorer groups:
1. Social drift- people in early stages of
schizophrenia drift down to a lower
social class as a result of mental
impairment
2. Social stress- social stresses of poverty,
deprivation, and social disorganization
increase risk
3. Neurodevelopment- lower class members
of the population may encounter more
neurodevelopmental risk from obstetric
complications and or perinatal infection
Schizophrenia, Warner and de Girolamo 1995
10. Famine and
Malnutrition
❖ Prenatal nutrition
➢ Malnourished mothers may not
get enough folate in the diet
■ Folate deficiencies may
cause genetic mutations in
developing fetus that can
lead to schizophrenia
❖ Those born during times of
famine more than twice as
likely to develop
schizophrenia as those born
during years of adequate
food
http://www.nytimes.com/health/guides/disease/schizo
phrenia/risk-factors.html
11. Homelessness and Mental Illness
❖ Mental illness disrupts aspects of daily life
➢ Self care, household management
❖ Physical health
➢ Neglect to take necessary precautions against disease
➢ Combined with lack of proper hygiene this may lead to respiratory infections, skin
diseases, exposure to tuberculosis or HIV
➢ Half of the mentally ill homeless population suffers from substance abuse and
dependence
➢ Malnutrition
❖ Mental illness is the third largest cause of homelessness in single adults
http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf
12. Homelessness and Mental Illness
❖ Developing countries emphasize healing and destigmatization and
reintegration into the community compared to Western culture in which
psychotic episodes often lead to increased alienation
❖ Community care is cheaper than hospitals
➢ At home care focused on treating the individual while reintroducing to society
■ No extra cost to the taxpayer
❖ Developing countries have greater opportunities for work and meaningful
employment
➢ Rural, nonwage consistency economies
➢ There is no real concept of unemployment and there is always a work role
➢ Western culture promotes 40 hr work weeks
Schizophrenia, Birchwood and Jackson, 2001
13. Costs of Homelessness
❖ Hospitalization and medical treatment
➢ Spend, on average, 4 days longer in the hospital than a non-homeless patient
■ $2,214 per hospitalization
■ Annually about $3.5-4 million in admission costs
❖ Incarceration and police intervention
➢ Laws specifically target loitering, sleeping in cars, begging
➢ Each person cost the taxpayers $14,480 per year primarily for overnight jail
➢ A typical cost of a prison bed in state or federal prison is $20,000 annually
❖ Emergency shelter expenses
➢ Cost of providing to families is equal to or more expensive than placing them in
transitional or permanent housing
http://www.endhomelessness.org/pages/cost_of_homelessness
15. Premorbid Adjustment
❖ Late adolescence, early adulthood
➢ Measured on factors as a person’s ability to establish and maintain friendships and sexual
relationships
➢ Performance at school and work tends to decline significantly in those showing poor
premorbid adjustment
➢ Report an insidious build up when symptoms gradually worsen until the psychotic
symptoms are apparent
❖ Children
➢ Pattern of difficulty in emotional development (i.e. becoming easily upset), inappropriate
classroom behavior, and difficulties in forming and maintaining relationships
Schizophrenia, Birchwood and Jackson 2001
